European Journal of Cardiovascular Medicine

Ectopic Pregnancy is a term originated from ‘Ektopos’, a Greek word. There is implantation of fertilised ovum outside the endometrial cavity of the uterus [1]. The incidence of Ectopic Pregnancy noted to be 1-2% globally [2]. Ectopic pregnancy is assuming greater importance because of its increasing incidence and its impact on women’s fertility [3,4] and also remains as the leading cause of maternal deaths in early pregnancy [5]. One of the greatest challenges for a physician is early diagnosis of an ectopic pregnancy. Ectopic pregnancies are mostly suspected between 6-10 weeks of pregnancy. Although the rates of ectopic pregnancy are not falling in the developed world but mortality and morbidity are falling because of early diagnosis and treatment [6]. Even today, it accounts for around 6% of pregnancy-associated mortality [7,2]. Ruptured ectopic pregnancy can cause severe haemorrhage and maternal mortality in the first trimester [8]. Since, ectopic pregnancy is an important health problem among the reproductive age group women, the study was aimed to determine the incidence, risk factors, clinical features, mortality and various treatment options of ectopic pregnancy in order to reduce the incidence and mortality.

AIMS AND OBJECTIVES

To determine the incidence, risk factors, clinical features, mortality and various treatment options of ectopic pregnancy.

1. To determine the incidence, risk factors, clinical features and treatment of ectopic pregnancy.
2. To study the mortality associated with ectopic pregnancy.

A sum total of 50 cases of ectopic pregnancy was included in this cross-sectional, observational study. All were informed regarding the study with their written consent. Ethical approval was also obtained before recruiting patients in the study. The diagnosis and location of pregnancy were confirmed during the operation for ectopic pregnancy patients who received surgical treatment. Among patients who received medical treatment, the diagnosis was confirmed by a combination of serum beta-human chorionic gonadotropin (b-hCG) level and transvaginal ultrasonography or ultrasonography of pelvic organ. Parameters about blood group, parity, history of previous ectopic pregnancy, previous abdominal surgery, history of dilatation and curettage, pelvic inflammatory disease, usage of intrauterine device and other contraceptives, risk factors, clinical features, site of ectopic pregnancy and treatment modality was recorded.

Study design - Hospital based Observational study

Sample size - 50 cases

Study population - Cases attending Obstetrics and Gynaecology department, JMCH

Sampling technique - Consecutive sampling

Study duration - From March 2023 to August 2023.

Inclusion criteria

• Clinically and ultrasound diagnosed ectopic pregnancy cases
• Chronic ectopic pregnancies
• Heterotrophic pregnancies

Exclusion criteria

• Molar pregnancy
• Intrauterine pregnancy
• Abortion

In the present study, 50 cases of ectopic pregnancy were observed and treated. During the period of study, there was 3586 deliveries in the hospital including stillbirth. The incidence of ectopic pregnancy came out to be 1.394.

AGE OF THE STUDY PARTICIPANTS

FIGURE 1

              46% of patients belongs to more than 30 years of age. Only 2% patient belongs to below 20 years of age.

PARITY IF THE PATIENTS

FIGURE 2

28% patients were nulliparous, 36% were primiparous and remaining 36% were multiparous.

RISK FACTORS

TABLE NO. 1

              Previous abortion was the most common risk factor followed by PID, previous LSCS and sterilisation.

In 17 patients (34%), more than one risk factors were seen.

No risk factors were identified in 10 (20%) cases.

PRESENTING CLINICAL SYMPTOMS

TABLE NO. 2

Classical triad of ectopic pregnancy was seen only in 17 (34%) patients. The most common symptoms were abdominal pain and amenorrhoea seen in 44 (88%) and 43 (86%) of patients, respectively.

PERIOD OF AMENORRHOEA

FIGURE 3

              LMP was not known in 7(14%) patients. 11(22%) patients were presented with <6weeks of amenorrhoea. 23 (46%) patients were presented with 6-9 weeks of amenorrhoea. 9(18%) patients had more than 9 weeks of amenorrhoea.

PER ABDOMINAL EXAMINATION FINDINGS

FIGURE 4

4 (8%) patients had no abdominal findings. Only tenderness was found in 11(22%) of patients. Only distension and guarding were found in 2 (4%) patients each. In 29 (58%) patients, distension, tenderness and guarding all three were seen.

PER VAGINAL EXAMINATION FINDINGS

FIGURE 5

              Adnexal mass was found in 1(2%) patient. Forniceal fullness only was seen in 11(22%) patients whereas forniceal tenderness was seen in 12(24%) patients. 7(14%) patients had no findings and 19(38%) patients had both forniceal tenderness and fullness.

CLINICAL DIAGNOSIS

FIGURE 6

              Clinical diagnosis was ectopic pregnancy in 49 (98%) patients and heterotrophic pregnancy in 1 (2%) patient.

TYPES OF ECTOPIC PREGNANCY

FIGURE 7

              40 (80%) patients had acute ectopic pregnancy and 4 (8%) patients had chronic ectopic pregnancy.

SITE OF THE ECTOPIC PREGNANCY

TABLE NO. 3

              Most common site was ampulla followed by cornual. Site could not be identified in 3 (6%) of patients.

CONDITION OF TUBES

TABLE NO. 4

Majority of patient, i.e., 39 (78%) had ruptured ectopic pregnancy.

MANAGEMENT

TABLE NO. 5

              Majority of patients under went right side salpingectomy and left side salpingectomy. 2 (4%) of patient underwent abdominal hysterectomy. 1 (2%) patient underwent cornual resection, 1 (2%) underwent dilatation and evacuation and 1 (2%) underwent medical management.

The present study was undertaken to determine the occurrence, risk factors, clinical profile, mortality and various treatment options of ectopic pregnancy. The results and observations of the present study are compared in this chapter in the light of available data, information and observations made by other workers in similar region or elsewhere.

Multigravida comprised of 36% of study subjects. Multiparous woman was found to be more prone to ectopic pregnancy in Gaddagi et al i.e. 62.2%; Shetty et al i.e. around 83.9% and Khaleeque et al study about 61% [10,9,14].

In present study, abdominal pain and amenorrhea was present in 88% and 86% cases suggestive of most common presentation of patient with ectopic pregnancy. Shetty S et al observed the commonest symptoms were abdominal pain (80.6%), amenorrhea (77.4%) and abnormal vaginal bleeding (61.3%) cases [9]. Gaddagi et al observed that a majority of the cases presented with pain in the abdomen (89.2% of cases); amenorrhea was seen in 75.7% cases and spotting per vaginum in 43.2% cases [10].

The most common site of ectopic pregnancy in this study was ampulla accounting for 52% followed by cornua accounting for 16%. In study by Shetty S et al, commonest site of location of the ectopic pregnancy was in the ampulla of the fallopian tube seen in 45.2% cases [9].  Similar findings were seen by Gaddagi R et al in his study i.e. majority of the cases were ampullary pregnancies (69.7%) [10].

Ectopic pregnancy is a gynaecological emergency and is on rising trend. It is necessary to devise means of early detection and treatment. History of abortion and Pelvic inflammatory disease were found to be most important risk factors in ectopic pregnancies. Women of reproductive age group should be educated about the risk factors and warning symptoms of ectopic pregnancy

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